By Dennis Thompson
Music can help soothe the fear and anxiety of critically ill patients who have been placed on ventilators, reducing both their stress and their need for sedatives, according to a new study.
Intensive care unit (ICU) patients allowed to listen to music of their choice whenever they liked enjoyed a 36 percent reduction in their anxiety levels compared to patients not offered music, researchers found.
The ICU patients who were provided music also needed less sedation, with their sedative intake dropping 38 percent compared to other patients, the findings showed.
"They had significantly less anxiety, and they also received less frequent and less intense sedatives and medication," said lead author Linda Chlan, of Ohio State University. "We can use music to reduce the common symptom of anxiety along with less medicine to promote patient comfort."
The study, published online May 20 in the Journal of the American Medical Association, involved 373 patients from 12 ICUs at five hospitals in the Minneapolis-St. Paul area. All patients had been placed on a ventilator between September 2006 and March 2011 due to respiratory failure.
A group of 126 patients were offered the opportunity to listen to music of their own choice through headphones whenever they liked.
"The music patients listened to was tailored to them based on their musical preferences determined by the music therapist on our research team," Chlan said. "The interesting thing about that, we all have different preferences. Really, it ran the gamut. So much of it has to do with age, whether or not someone's a musician, that type of thing." Oldies and classical music were two favorite choices.
The study also involved two control groups who were either provided usual care or given the choice to wear noise-canceling headphones whenever they wanted to block out hospital noise. All three patient groups had their anxiety levels measured daily as well as the intensity and frequency of the sedation they required.
During the five-day study period, patients allowed to listen to music needed less sedation and felt less anxiety than patients receiving usual care. They also needed fewer doses of sedatives than patients wearing noise-cancelling headphones, but did not experience a comparatively significant reduction in anxiety or sedation intensity.
Patients with music listened for an average of 80 minutes a day, while patients with noise-canceling headphones used them an average of 34 minutes a day, the study authors noted.
Music therapist Barbara Else, a senior advisor to the American Music Therapy Association, called the new report "an important study for the music therapy profession."
"While this topic is not new in the music therapy research literature, this study demonstrates one of the valuable roles board-certified music therapists can provide within the context of the interdisciplinary team, working with patients and in cooperation with critical care nursing staff," said Else, who was not involved with the research.
She said it "was also valuable because the protocol designed by ... Chlan and colleagues provided the patient with some control. Patients could control when and how long they used the music intervention each day or night. The music selections were tailored by the music therapist, working with the patient."
Chlan said she got the idea of self-administered music therapy from observing the practice of patient-controlled analgesia in hospital settings. ICU patients on ventilators aren't allowed to control their intake of pain medication, but she thought providing them the choice of their own music might provide them some small sense of control.
"Patients are more satisfied with pain control when they can administer their own medicine," Chlan said. "I thought, 'Well, I wonder, if we can encourage and empower patients to use preferred relaxing music, can we help reduce their anxiety level?' It really is unusual to empower patients in the ICU, and this study is novel in that the patients decided for themselves when they wanted to listen to music."
It was vital to allow patients to choose their own music. "We all have musical memories, and those types of music we have pleasant memories from we need to maximize," Chlan said.
Music also has been shown to reduce levels of stress hormones in the body, and can block out the disconcerting background noises that occur in a hospital setting, she said.
"Music provides a very complex auditory stimulus," Chlan said. "It can occupy areas of the brain with a pleasant comforting stimulus, which can block out unpleasant hospital stimulus. People think, 'Oh, music is just something nice to listen to,' but it's so much more than that."
Visit the American Music Therapy Association to learn more about the connection between music and health.